基于有限元模型评价切开保留皮桥术式治疗后马蹄形肛周脓肿的效果  

Finite element model-based evaluation of the effectiveness of the incisional skin bridge procedure for posterior horseshoe perianal abscess

作　　者：石荣 王菁 柯敏辉[2] 陈祖清 黄娟 陈日齐[3] 汪昭楚 Shi Rong;Wang Jing;Ke Minhui;Chen Zuqing;Huang Juan;Chen Riqi;Wang Zhaochu(Department of Anorectal Surgery,Affiliated People’s Hospital of Fujian Traditional Chinese Medicine University(Fujian Peo-ple’s Hospital),Fuzhou 350004,Fujian,China;Department of Anorectal Surgery,the Second People’s Hospital Affiliated to Fujian Traditional Chinese Medicine University,Fuzhou 350003,Fujian,China;Fuzhou University,Fuzhou 350108,Fujian,China)

机构地区：[1]福建中医药大学附属人民医院(福建省人民医院)肛肠科,福建福州350004 [2]福建中医药大学附属第二人民医院肛肠科,福建福州350003 [3]福州大学,福建福州350108

出　　处：《结直肠肛门外科》2023年第5期469-473,共5页Journal of Colorectal & Anal Surgery

基　　金：国家自然科学基金项目(81973852);国家中医药管理局2022年国医大师陈民藩传承工作室建设项目(国中医药办人教函[2022]245号)。

摘　　要：目的 基于有限元模型评价切开保留皮桥术式治疗后马蹄形肛周脓肿的效果。方法 纳入2020年9月至2022年12月就诊于福建中医药大学附属人民医院(福建省人民医院)肛肠科行肛周脓肿切开保留皮桥手术治疗的120例后马蹄形肛周脓肿患者作为研究对象。按照随机数字表法将患者随机分为正常皮桥组、宽皮桥组,每组各60例。构建切开保留皮桥术式的正常皮桥三维有限元模型A和宽皮桥模型B,在切开保留皮桥术中测量皮桥节点的综合应力及位移量,输入对应的模型中。选取皮桥上6个节点,验证模型的有效性,之后比较两模型的位移量差异,以及术后3个月患者肛门压力的差异。结果 正常皮桥组174节点、宽皮桥组173节点手术测量位移量与模型的位移量存在差异(P <0.05),其余节点手术测量位移量与模型位移量比较无明显差异(P> 0.05);与模型B相比,模型A皮桥内侧缘89、173、257节点位移量较小(P <0.05),外侧缘90、258节点位移量较大(P <0.05);两模型皮桥内侧缘89、173、257节点的位移量均大于外侧缘90、174、258节点位移量(P <0.05);正常皮桥组术后3个月的肛管静息压、肛管最大收缩压均高于宽皮桥组(P <0.001)。结论 有限元法可模拟肛周脓肿切开保留皮桥术式的生物力学特性,术中皮桥不同节点受到不同程度的牵引力,合理的皮桥设计可能是维持肛周脓肿术后肛门形态、维护肛门功能的关键。Objectives To evaluate the effectiveness of the incisional skin-bridge procedure in the treatment of posterior horseshoe perianal abscess based on finite element model.Methods A cohort of 120 patients with posterior horseshoe perianal abscess who underwent the incisional skin-bridge procedure in the Department of Anorectal Surgery,Affiliated People’s Hospital of Fujian Traditional Chinese Medicine University(Fujian People’s Hospital)from September 2020 to December 2022 were included.These patients were randomly assigned into either standard skin-bridge group or the wide skin-bridge group(60 patients each)using random number table.Three-dimensional finite element model for both the standard skin-bridge(model A)and wide skin-bridge(model B)were constructed.Stress and displacement metrics at various skin-bridge nodes during surgery were quantified and incorporated into their respective models.Six pivotal nodes were selected for model validation,followed by comparisons of displacement disparities between the two models and an evaluation of anal pressure three months post-surgery.Results Displacements measured surgically at 174 nodes in the standard skin-bridge group and 173 nodes in the wide skin-bridge group significantly deviated from the model prediction(P<0.05),whereas other nodes displacements measured surgically aligned with the model(P>0.05).Compared to model B,nodes 89,173,and 257 located on model A’s inner skin-bridge edge showed markedly less displacements(P<0.05),while nodes 90 and 258 on the outer edge exhibited increased greater displacements(P<0.05).Inner edge displacements were substantially greater than those at the outer edge in both models(P<0.05).Postoperative three-month anal pressure revealed that the anal resting pressure and maximal contraction pressure of the standard skin-bridge group surpassed those of the wide skin-bridge group(P<0.001).Conclusion The finite element method efficaciously mirrors the biomechanical dynamics of incision and skin-bridge procedures for perianal abscesses.Du

关 键 词：后马蹄形肛周脓肿 切开保留皮桥术 有限元模型 

分 类 号：R657.1[医药卫生—外科学]